Cultural Awareness - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Cultural Awareness

• Recognizes and values individual and cultural differences.
• Is sensitive to the similarities and differences that exist between cultures.
• Interacts effectively with people from different cultural backgrounds.
• Is willing to include individuals with different cultural backgrounds on the team.
• Understands the impact that our culture may have on interactions between individuals.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Problem Solving

• Ability to develop innovative solutions to problems.
• Effective in solving problems.
• Actively seeks the root cause of a problem.
• Finds creative ways to get things done with limited resources.
• Solves problems using logic and insight.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Technical

• Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
• Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
• Is knowledgeable of procedures or systems necessary for the job.
• Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
• Willingly shares his/her technical expertise; sought out as resource by others

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Objectives

• Encourages me to take on greater responsibility.
• Ability to establish realistic goals.
• Communicates goals and objectives to employees.
• Works toward achieving established goals and objectives.
• Establishes goals and objectives.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Trustworthy

• Demonstrates congruence between statements and actions.
• Consistently keeps commitments.
• Takes care to maintain confidential information.
• Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
• Communicates an understanding of the other person's interests, needs and concerns.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.